Coverys Red Signal Report Details Evolving Risks of Primary Care

For primary care physicians, diagnostic errors are the leading type of malpractice claim, accounting for the highest proportion of indemnity paid, according to a just-released Primary Care Red Signal Report from Coverys. The analysis of primary care claims is the second in a planned series of claims-trend reporting intended to identify risks and illuminate safety vulnerabilities within the U.S. healthcare delivery system.

“In primary care, the big area of concern is missed and delayed diagnoses,” said Robert Hanscom, Coverys vice president and co-author of the report. “To a number of people, that may come as a surprise, but it’s because many of those claims involve a missed cancer diagnosis. A lot of times, doctors aren’t even aware that they’ve missed a diagnosis until way, way after the fact when they suddenly receive a claim letter or are named in a lawsuit. We want primary care physicians, who are constantly making diagnoses, to know that, in fact, this is an area of great vulnerability for them.”

There is no question that the risk profile for primary care physicians has expanded with the evolution of the specialty. The Primary Care Red Signal Report notes that the primary care physician role has become increasingly challenging, with yesterday’s family doctor now accountable for all aspects of the patient care continuum, including referral management, management of multi-morbidities and transfer to longterm care, all while keeping a sharp eye on utilization, appropriate level of care and patient quality metric outcomes.

Following are some highlights from the Primary Care Red Signal Report:

• Among the top clinical conditions associated with a diagnostic failure in primary care, cancer cases are the most frequent, constituting 50 percent of diagnosis-related claims. The next highest categories are infections (19%), cardiac/vascular (16%), and myocardial infarction-related injuries (11%). The top missed cancer diagnoses are colorectal (20%), lung (19%), prostate (11%), bladder (9%) and breast (8%).
• Treatment-related claims are the second-most common malpractice allegation against primary care physicians. These claims are frequently associated with cardiac treatments, pain management, wound care and blood administration. They also can be related to allegations of unnecessary treatments or scenarios involving the wrong patient. The top medical treatment allegations are management of treatment (accounting for more than 60 percent of the claims), failure to treat and delay in treatment.
• Medication-related malpractice claims against primary care physicians often result in high-severity adverse outcomes. Approx-imately 45 percent of the medication-related claims, and more than half of the indemnity dollars paid, are directly related to allegations of inattentive monitoring and management of medication. Medication ordering is the second most frequent claim allegation, constituting approximately one-third of the medication-related claims and 38 percent of the indemnity dollars.
• Transitions in care can be fraught with fragmented instructions and inconsistencies if not managed correctly. The top claim associated with transitions of care involves a delay or failure to obtain a specialty consult when clinically indicated (38%). Other fraught areas include failure to coordinate follow-up care, communication breakdowns among multiple physicians who may be providing care to a single patient, not working as a cohesive clinical team and a failure or delay in transferring to an alternative facility.
• Primary care physicians need a strategy to address and monitor their risks. Coverys recommends improving diagnostic accuracy and treatment by regularly performing a complete age-appropriate history and physical exam on every patient that includes cancer screening; closing the referral loop by implementing a system to track, review, document and communicate all test results to patients; implementing a process for obtaining informed consent when high-risk medications are prescribed; and ensuring safe care transitions takes place by offering care coordination as well as follow-up appointments for patients with complex medical needs.

This article provided by Medical Liability Monitor.